Consider for a moment what will come next for Obamacare, in the context of Ezra Kleins five thoughts on the disastrous launch of the program  a bellwether of sorts for obamacare-logo_fullhow the administration failed to live up to the expectations it sold to the laws supporters and opinion leaders.

There are a few different directions it can go from here, but the worst case scenario hasnt really entered peoples consciences yet, in part because the insurers are staying quiet at the moment. The reality now is that the system is at least a month from actually working, and likelier two or (gasp) three, given the enormous range of problems. And that could make for a real disaster.

As it stands today, at most nine of the state exchanges are working but while some systems are being announced as fixed on the state level, fixed in this case means the ability to look at plans, not to actually enroll. And the fundamental breakdown for the federal exchange hangs on a decision designed to insulate people from the true cost of plans  an approach which is now backfiring given the load it places on the website. The whole storyline is marked by a disturbing failure of basic technocracy: according to the New York Times, as late as the last week of September, HHS officials were still debating aspects of the site, including that requirement making customers register before shopping for insurance.

Democrats are scrambling for excuses: there wasnt enough money or time. The decision to delay controversial regulations til after the 2012 election slowed the process. The Republican governors ruined efforts by opting not to implement exchanges. The suggestion that cronyism played a role in the contractor process is already being advanced. But cronyism or no, the decision of those at CMS/HHS to take the lead in organizing the program  despite an enormous absence of institutional experience  may be the real source of the problem. Megan McArdle outlines the reality:

"Im a longtime critic of federal contracting rules, which prevent some corruption at ruinous expense in money, quality and speed. But federal contracting rules are not what made the administration delay writing the rules and specifications necessary to build the system until 2013. Nor to delay the deadline for states to declare whether theyd be building an exchange, in the desperate hope that a few more governors might decide  in February 2013!  to build a state system after all. Any state that decided to start such a project at that late date would have had little hope of building anything that worked, but presumably angry voters would be calling the governor instead of HHS. Federal contracting codes, so far as I am aware, do not emit intoxicating gases that might have caused senior HHS officials to decide that it was a good idea to take on the role of lead contractor  a decision equivalent to someone who has never even hung a picture deciding that they should become their own general contractor and build a house. Nor can those rules explain their lunatic response when they were told that the system was not working  failure was not an option.

But whether these excuses work with the public or not, the worst case scenario for Obamacare is now entering the realm of possibility: what if it just doesnt work, and continues not to work, a month from now? The deadlines for achieving coverage are approaching fast. The political reality is that its impossible to legally require people to sign up for something when the system just wont let them. If a month from now we are still seeing a fail rate of significance within these systems, where people trying to enroll are turned away as often (or more often!) than they get through, the pressure from non-partisan actors is going to explode for a delay of major aspects of the law. It will be a murmur at first, but if it continues to grow, there will have to be a Congressional response.

One factor to consider here is that the consultants involved for the federal and state exchanges have a good deal of overlap. It would be one thing if it were just a few states having issues  they could prioritize the major states over the minor ones  but the fact that the problems are worst for the federal exchange means none of the states are going to get significant attention until thats taken care of. This could mean smaller states get attention last, leaving their citizens incapable of purchasing the coverage theyre legally required to get. The potential for legal challenges coming out of this is massive if the mandate/penalty is not delayed. But to solve the practical problem requires steps beyond just the individual mandate delay or extending open enrollment for the entire year  were talking about actually taking the exchanges offline (insurers would presumably honor the handful of plans already sold through them) in order to fix them. That process could take months of work and millions more in taxpayer dollars and set us up to do this whole thing again in October of 2014.

So whats the worst case scenario? Honestly, its this: if this is as big of a failure as it looks like at the moment, and the problems are not fixed within the next two months, the Obamacare project could end up backfiring in a way that could have dramatic effects on politics and policy going forward. It will contribute to distrust in governments basic capability. It will fail to live up to its promise, and wreck the insurance markets for no good purpose. It will represent the administration betraying its strongest supporters. And it may ultimately leave President Obama wishing John Roberts had ruled the other way  turning him into a martyr for the cause as opposed to putting the burden of proof on actually implementing his signature policy.

Cost necessarily skyrockets.Access becomes more difficult.Politics enters the equation of who gets care and when.Death panels decide who lives and who dies.Political party membership pressure increases.Hackers steal personal information.Qualified students opt out of medical careers.It becomes increasingly common to have language barriers with physicians. Individual life style choices come under scrutiny and regulation based on perceived cost to "the state".

16
posted on 10/16/2013 1:30:22 PM PDT
by Amagi
(Lenin: "Socialized Medicine is the Keystone to the Arch of the Socialist State.")

...if this is as big of a failure as it looks like at the moment, and the problems are not fixed within the next two months, the Obamacare project could end up backfiring in a way that could have dramatic effects on politics and policy going forward. It will contribute to distrust in governments basic capability. It will fail to live up to its promise, and wreck the insurance markets for no good purpose. It will represent the administration betraying its strongest supporters. And it may ultimately leave President Obama wishing John Roberts had ruled the other way

Single payer only happens if a convincing argument can be made that the private sector/corporatist option failed.

Healthcare.gov is simply collapsing too fast to pin the blame on the healthcare industry. Obama and the Dems OWN it. Come next year they’re going to be begging for the very delay the Republicans lost trying to bring about.

When all of these people get insurance, where do you think they are going to go for care? There are no doctors. And they will be camping out at the Community Hospital ERs. They will not pay their co pays or deductibles. Hospitals will have to eat that.

Community hospitals will shut down because of increased cost and less income.

Do nothing.
Refuse to negotiate.
After the names good people have been called by Obama.
After Reid’s insults to the other party.
After the libel against the Tea Party.
After the disrespect shown to military families.
After the disrespect leveled at veterans.
After the accusations against the Catholics and their church.....
and on and on
I would not lift a finger to save the dirty democrat progressive socialists that have brought this to the people. Nothing.

32
posted on 10/16/2013 1:55:04 PM PDT
by Rapscallion
(With more E-mail and telephone surveillance do you feel more secure?)

He wont ask. He will just do it and nobody in Congress will stop him.

I don't believe HE will do anything. He is incapable of making a decision and will continue to fiddle in denial while healthcare burns.

I'll bet a bottle of good liquor (your/my choice) that the exchanges will still not be working March 31, 2014. I've seen software project meltdowns before, and this one is a doozie! They are going to have to trash the whole thing and redesign/rewrite from scratch.

You underestimate the libs and their media accomplices. Already, the message is that any problems are the fault of those greedy insurance companies, and that the only fix is for the government to take over. As more and more low information voters find out how expensive this “free” healthcare is going to be under Obamacare, they will be easily induced to pressure lawmakers for government-run healthcare.

Private insurance companies wrote most of the bill. It boggles my mind how so many people fail to accept that. Let's peek at their stock prices today (I know, Wall Street perception isn't "proof," but it's quick and dirty for now.)

On and on. It's like this every day. Is there risk? Sure there is, but it was a calculated risk by the insurance companies all along and it has been, thus far, pretty damn good for them. They sure as hell don't want single payer, and since they are the top lobbyists in Washington (#1 or #2 anyway), I can't see that happening anytime soon.

You gotta be an industrial strength optimist-—March 31 is half a year away!!. If it lasts anywhere near that long I’ll bring a bottle over and we’ll share it while it eats itself the rest of the way. I don’t see needing more than one bottle when this hermaphrodite starts eating its own skin-—it just won’t take long.

Im no computer expert, but theres not enough bandwidth to handle anything close to routine traffic.

Did you accidentally comment on the wrong thread? No indication that insufficient bandwidth has anything to do with the website failures. However, they'd love for that to be the case since it would be so easy to fix.

45
posted on 10/16/2013 2:53:04 PM PDT
by steve86
(Some things aren't really true but you wouldn't be half surprised if they were.)

Even if the web site gets fixed, enrollment will be dismal especially among the younger generation. Given low enrollment due to the high cost and questionable access to the promised subsidies coupled with the likely repeal of some of the new taxes funding Obamacare, the system will go broke in a year and even more people will be without health insurance. The Democrats fix will be to pass a single payer socialized medicine plan of course exempting Congress and government officials who will enjoy a Cadillac plan unavailable to the peons.

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